The back pain files: Chiropractic care as the first line of treatment
By Dr. Michelle Lim, D.C.
More and more people are seeking treatment for back pain. How does surgery stack up against Chiropractic?
“America spends more than $80 billion a year on back pain treatments. But many specialists say less treatment is usually more effective… In fact, there’s evidence that many standard treatments for back pain — surgery, spinal injections and painkillers — are often ineffective and can even worsen and prolong the problem.” -NPR.com
Dr. Richard Deyo, an authority on evidence-based medicine at Oregon Health Sciences University who has studied treatment of back pain, says, “There’s good reason to think that we are overprescribing painkillers, overprescribing injections, and overprescribing back surgery.”
MRIs may not be diagnostic of back pain
He blames it on the ready availability of advanced technology. With the accessibility of MRI scans, physicians are able to visualize a cross-section of the spine and more often than not, find abnormalities in the scan. With a direct image of bulging and degenerated discs, he believes this is the reason invasive treatments for back pain have been on the rise in recent years. Physicians see things that warrant attention and attribute these findings to the cause of back pain, but Dr. Deyo believes this may be fatally misleading. Most likely this is not the cause of pain.
According to NPR.com, lots of people who are pain-free actually have terrible-looking MRIs. And among those who have MRI abnormalities and pain, many specialists question whether the abnormality is really the cause of the pain, and whether fixing it can make the pain go away. “Research is showing that the pain often has nothing to do with the mechanics of the spine, but with the way the nervous system is behaving, according to physiatrist Dr. James Rainville of New England Baptist Hospital in Boston.”
Published in the journal Spine, pressure pain thresholds were tested in 20 patients with chronic lower back pain and 20 healthy individuals. The authors found that patients with back pain had reduced pressure pain thresholds than healthy patients. The study suggested that these patients suffered from hyperalgesia, or a hypersensitivity to pain, which is indicative of central sensitization. Central sensitization occurs when the entire central nervous system becomes overly sensitive to pain and is quick to react at the slightest sign of a threat.
Doctors of Chiropractic can help with central sensitization by restoring balance to an overactive nervous system. Chiropractors can calm flare-ups in chronic pain by correcting any spinal dysfunction that can be contributing to or causing symptoms.
A 2011 study published in the Journal of Occupational Environmental Medicine suggested that chiropractic patients [who had] back pain had a lower risk for recurring symptoms compared to patients under standard medical care or care provided by a physical therapist.
Chiropractors have been advocating conservative care for years and the evidence is in the research. According to the Journal of American Medical Association, in an article on low back pain, “surgery is not usually needed and should only be considered if more conservative therapies fail”.
There are times when some cases call for surgery, but most of the time it’s not indicative. Research suggests that less than 5% of people with back pain are actual candidates for surgery, while the 1 in 5 patients who have surgery for back pain end up having more surgery. The information in JAMA reinforces the American Chiropractic Association’s (ACA) position that conservative care options should serve as a first line of defense against pain, including chiropractic care.
In a randomized trial by researchers at an outpatient rehabilitation department in Italy involving 210 patients with chronic, non-specific low back pain, they concluded that spinal manipulation provided better short and long-term functional improvement, and more pain relief in the follow-up rather than either back school (back exercises) or individual physiotherapy.
Another randomized, double-blinded, placebo-controlled, parallel trial published in Spine, 2013 found that a subgroup of patients with acute nonspecific LBP (low back pain) responded better to spinal manipulation significantly better than non steroidal anti-inflammatory drug (diclofenac) and was clinically superior to placebo.
Furthermore, The Journal of Manipulative and Physiological Therapeutics have shown lower overall episode costs for treatment of low back pain if they had initiated care with a DC (Doctor of Chiropractic), when compared to those who initiated with an MD.
Dr. Lim explains the importance of spinal care and the benefits of Chiropractic Care
So not only is Chiropractic considered conservative care, but it is overall cost-effective and reduces the likelihood of recurring back pain. There’s no adverse side effects and it works with your body rather than against it, by relying on the body’s own ability to heal itself. If you have back pain, you should seek chiropractic care before getting corticosteroid shots, painkillers or scheduling surgery. Those are quick and easy band-aids that may or may not alleviate the pain, but may not always correct the source of the problem.
It’s time to rethink the current model of health and choose care that resonates with you. Chiropractic, in combination with a healthy lifestyle, including proper diet and exercise, can help alleviate most back problems. Are you willing to put your life at risk with surgery and alter your body for pain that may or may not go away and can be treated with conservative Chiropractic care instead? Try Chiropractic before resorting to other costly, invasive treatments.
1. Cifuentes, Manuel, Joanna Willetts, and Radoslaw Wasiak. “Health Maintenance Care in Work-Related Low Back Pain and Its Association With Disability Recurrence.” Journal of Occupational and Environmental Medicine 53.4 (2011): 396-404. Print.
2. Imamura, Marta, Janini Chen, Suely Reiko Matsubayashi, Rosa A. Targino, Fábio Marcon Alfieri, Daniel Kamura Bueno, and Wu Tu Hsing. “Changes in Pressure Pain Threshold in Patients With Chronic Nonspecific Low Back Pain.”Spine 38.24 (2013): 2098-2107. Print.
4. Lilidahl, Richard, Michael Finch, David Axene, and Christine Goertz. “Cost of Care for Common Back Pain Conditions Initiated With Chiropractic Doctor vs Medical Doctor/Doctor of Osteopathy as First Physician: Experience of One Tennessee-Based General Health Insurer.” Journal of Manipulative and Physiological Therapeutics 33.9 (2010): 640-643. Print.
5. Murphy, Donald R., Eric L. Hurwitz, and Ericka E. Mcgovern. “A Nonsurgical Approach to the Management of Patients With Lumbar Radiculopathy Secondary to Herniated Disk: A Prospective Observational Cohort Study With Follow-Up.” Journal of Manipulative and Physiological Therapeutics 32.9 (2009): 723-733. Print.
6. von Heymann, Wolfgang J., Patrick Schloemer, Juergen Timm, and Bernd Muehlbauer. “Spinal High-Velocity Low Amplitude Manipulation in Acute Nonspecific Low Back Pain: A Double-Blinded Randomized Controlled Trial in Comparison With Diclofenac and Placebo.” Spine 38.7 (2013): 540-548. Print.
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